A "conscience" clause attached to the House of Representatives’ 2005 appropriations bill for the Departments of Labor, Health and Human Services, and Education protects healthcare providers that will not provide abortions or refer patients for abortions.
The broad amendment, introduced by Dr Dave Weldon, a Florida Republican, says that funds in the bill may not be made available to a federal, state, or local programme that "subjects any institutional or individual health care entity to discrimination on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortions." An entity is "an individual physician or other health care professional, a hospital, a provider-sponsored organisation, a health maintenance organisation, a health insurance plan, or any other kind of health care facility, organisation, or plan."
The National Right to Life Committee said the amendment was an "urgently needed response to a national effort on the part of certain groups to employ the coercive powers of state and local government agencies and courts to force healthcare providers, including religiously affiliated hospitals, to perform or fund abortions."
The bill’s effect would be to immunise individual health workers and institutions from any penalty if they refused to provide abortions or refer patients, even in cases of rape or need for emergency care.
The effect will be felt mostly by poor women, who often depend on government subsidised health insurance and use Catholic hospitals, which provide care for about a fifth of Americans.
The bill was passed by the House. To become law, it must be passed by the Senate and signed by the president. The Senate bill does not contain the amendment. Both houses of Congress will adjourn in early October because of the presidential election, but this and other appropriations bills must be passed soon.
Cynthia Dailard, senior policy associate with the non-profit Alan Guttmacher Institute, told the BMJ that a House-Senate conference committee will probably negotiate the differences. Or this and other appropriations bills might be combined into an omnibus bill. The "conscience clause" might or might not remain in the final bill. However, Congress could extend existing funding and tackle the issue later.
Ms Dailard said it was unclear what would happen. "The House is certainly more strident and extreme when it comes to abortion related issues. The Senate is much more resistant to measures like the Weldon amendment that would prevent healthcare providers from providing referrals and preventing states from enforcing their own laws," she told the BMJ .
The bill is part of an effort by abortion opponents to allow health providers and organisations to refuse to provide contraception, emergency contraception, sterilisation, and abortion (28 August, p 476).
According to the Guttmacher Institute, most states have a "conscience" or "refusal" clause permitting health professionals or institutions to refuse to participate in certain reproductive health services, often on moral or religious grounds.
Mississippi passed the broadest law, which took effect in July. It allows any healthcare provider, payer, or employer who provides health benefits to refuse to participate in or pay for "a health care service that violates his or her conscience." The law does not mention specific healthcare services.
It also says, "No health care provider shall be civilly, criminally, or administratively liable for declining to participate in a health care service that violates his or her conscience" and "It shall be unlawful" for any provider, institution, public official, or medical board to discriminate against a person or institution that declines to provide a service that violates his or her conscience (http://billstatus.ls.state.ms.us/documents/2004/html/SB/2600-2699/SB2619SG.htm).
Pharmacists have been active in refusing to provide emergency contraception. Activist Karen Brauer, president of Pharmacists for Life, told the Associated Press that, "Forced referral is stupid. If we’re not going to kill a human being, we’re not going to help the customer go do it somewhere else."